(calm music)
- So I think one way to think of this
is part of the first time when you meet a patient
and we make a diagnosis,
we are trying to understand how extensive
is the injury to the body from vasculitis?
In fact, for many of our vasculitis diseases,
we borrow terminology from our cancer colleagues,
like staging, and we talk about different phases
of treatment like induction and remission maintenance.
This does not mean when we use these words
that a vasculitis patient has cancer,
but what it does mean is that just like cancer,
vasculitis can be widely active throughout the body,
or it can be focused on specific areas of the body,
and so based on that, we would decide
what is the intensity and duration of treatment
that we need to use?
So when we talk about rheumatic disease treatment
in general, we talk about different categories of drugs.
There are, first off,
fast-acting and slow-acting medications,
and unfortunately, really the fastest thing that we have
being able to get some sort of symptomatic relief
and some biological effect within a matter of hours
to days, the only thing we have in that category
is steroids, but as many of our patients know,
the side effects of steroids long term
are often much worse than almost all of the other
rheumatic drugs that we use to treat rheumatic disease
in general, not just vasculitis,
and so for most patients,
almost all patients with vasculitis,
we end up using other, what we call steroid-sparing
or non-steroid immunosuppressive drugs
to shut down or reprogram the immune system,
and then also, there is a chemotherapeutic agent
which is used for severe forms of vasculitis
called cytoxine,
but these are high intensity immunosuppressants.
(calm music)
So one of the things to remember with vasculitis
being injury to blood vessels,
part of the healing of blood vessels
really is increasing blood flow.
It really comes down to all the more
for purposes of healing,
and also just for longterm lifestyle and healthiness,
really being vigilant about a good cardiovascular regimen,
both in terms of diet and exercise.
For patients with, for example, giant cell arteritis
or Takayasu arteritis, the vasculitis diseases
which can attack the heart and the large vessels,
maintaining the overall health of those blood vessels
is key to preventing future complications.
We also know that atherosclerotic disease,
or cholesterol and hypertensive vessel disease
from aging and lifestyle, that patients with vasculitis,
and because of the prior injury from previous flares
sometimes can have a harder time recovering
from things like heart attack and stroke,
and so for that reason, we really emphasize
that patients who have had a history of vasculitis
be vigilant about maintaining a balanced healthy and diet
and exercising regularly.
So when you come to us and we establish a diagnosis
and we start treatment, while you may not feel well,
part of how well and how quickly you recover long term
is really a function of how soon can you start
getting back to regular physical activity,
even if that's just walking for five minutes a day.
Again, it really is a matter of increasing blood flow,
that there was something about this process
which enters into a positive feedback cycle
where it really can and does make a difference
of how quickly and how well you recover long term
from previous autoimmune injury.
(uplifting music)